|
Can a relationship work when both partners are still finding
themselves? David Batty looks at the rocky marriage between the NHS and
social services. Guardian
Society Monday February 11, 2002
Isn't it time for a really radical approach to the NHS (Blair gives hard
sell on public service reform, February 22): no new plans, no new authorities,
no new reorganisation, no new reforms, for at least five years? Guardian
letters Tuesday February 26, 2002
Hospitals siphon off cancer cash. NHS trusts are using extra
millions to meet targets on non-essential services, writes Anthony Browne.
Observer
Sunday March 17, 2002
Health check. NHS Alliance warns of 'change fatigue'. Patrick
Butler Guardian
Wednesday March 27, 2002
"The NHS could become a monetary black hole." Paul
Edwards, 49, is a consultant general surgeon at the Countess of Chester
hospital in north-west England. Since qualifying in 1977 from the University
of Cambridge, he has seen much change in hospitals. In the second of two
articles, he expresses concern about costs and shortages in hospital
staffing, and the money spent on successive NHS reorganisations. Guardian
Society Tuesday April 2, 2002
'"e don't have the funds to meet all the government
directives." Janet Hawes, 53, is chairwoman of Basildon primary
care trust which groups 23 GP practices and related local health services.
These trusts are part of the latest wave of NHS change, which is shifting
funds and functions from hospitals into primary care - the GP surgeries and
other health clinics people use in their communities. Guardian
Society Wednesday April 3, 2002
"Moving goalposts takes people's minds off delivering
healthcare." George Young, 45, is a GP in Birmingham. As a member
of the professional executive committee of the new south Birmingham primary
care trust, he is among those driving the latest wave of NHS change, which
is shifting funds and functions from hospitals into primary care - the GP
surgeries and other health services people use in their communities. Guardian
Society Wednesday April 3, 2002
"We do not have universal strong leadership within the NHS."
Andrew Gibson, 52, has been chief executive of City Hospitals NHS trust in
Sunderland, north-east England, since 1994. After a radical redesign of
services the trust has emerged with the Department of Health's top
three-star rating. Guardian
Society Thursday April 4, 2002
'Why is the government obsessed with hospitals?' Graham Peck, a manager of
community nursing services in south London, has seen no sign of promised new
grassroots funding. Guardian
Society Friday April 12, 2002
Labour initiatives 'overwhelm' NHS. Thinktank warns against
well-meaning directives. John Carvel, social affairs editor Guardian
Friday April 12, 2002
Labour came to power promising to save the NHS, but with no idea of how it
actually works. The result has been the biggest, and least noticed, series
of u-turns in any area of government policy. The Observer's Health Editor
assesses the human cost of New Labour's great NHS learning curve.
Anthony Browne Observer.co.uk
Sunday April 28, 2002
Multiple reforms 'are harming NHS'. David Batty Society
Wednesday May 22, 2002
Initiativitis strikes again. Mr Milburn should address his
addiction. Leader
Guardian Saturday May 25, 2002
Going nowhere. 'Illusion of progress' in public services.
Simon Parker Wednesday
June 12, 2002 The Guardian
People who persistently abuse the 999 ambulance service by making hoax or
inappropriate calls will face prosecution under a new "zero
tolerance" crackdown announced by ministers today. Patrick Butler
Society
Friday June 28, 2002
Teachers obliged to report abuse. Rebecca Smithers, education
correspondent Saturday
June 29, 2002 The Guardian
Plan to fine patients who miss appointments is labelled a debt-chasing
nightmare by head of BMA. Gaby Hinsliff, chief political correspondent
Sunday
June 30, 2002 The Observer
NHS mergers fail to boost service, say researchers. James Meikle,
health correspondent Guardian
Friday August 2, 2002
Exit toll on older people. Government drive to beat 'bed-blocking'
raises concerns. John Carvel
Wednesday September 18, 2002 The Guardian
Standards not structures. All parties should remember that mantra.
Leader
Thursday September 26, 2002 The Guardian
Whistleblower lifts lid on NHS culture of secrecy. A senior health
service official who was fired after revealing his hospital's financial
problems yesterday lifted the lid on what he claims is the culture of
deception now endemic in the NHS. Jo Revill, health editor
Sunday January 26, 2003 The Observer
Online commentary: The Observer today reports on the case of NHS
whistleblower Ian Perkin. Here he says that managers must be able to talk
honestly about the problems which the service faces.
Sunday
January 26, 2003
Major structural upheavals in the NHS have failed to benefit patients,
writes Peter Davies.
Thursday January 30, 2003
Tony Blair was warned by the health inspectorate yesterday that he is
putting improvement of the NHS at risk by making "punch drunk" managers begin
a further round of changes. John Carvel, social affairs editor
Friday
May 9, 2003 The Guardian
Health service reform is being sidetracked by an obsession with
"glamorous" structural changes - such as the proposed creation of foundation
hospitals - at the expense of practical improvements on the healthcare
frontline, the leader of the NHS Confederation, Gill Morgan, said today.
Patrick Butler in Glasgow
Wednesday June 25, 2003
The government was accused last night by a Blairite thinktank of tinkering
obsessively with the structure of the NHS instead of introducing the working
practices needed to improve patient care. John Carvel
Tuesday July 15, 2003 The Guardian
If 30 years ago someone had suggested that a future government would be
condemned for too much "initiativitis", political observers would have rubbed
their eyes in disbelief. Malcolm Dean
Wednesday July 30, 2003 The Guardian
Research that could bring long-term benefits to the nation's health is
being ignored in favour of politically attractive "quick hits", according to a
report by the NHS body responsible for promoting more healthy lifestyles.
James Meikle, health correspondent
Tuesday August 12, 2003 The Guardian
Initiatives put pay shake-up in jeopardy, nurses warn. Tash Shifrin
Tuesday October 14, 2003
NHS reorganisations have cost nearly £60m in redundancy pay, the
Department of Health (DoH) has admitted to MPs. Tash Shifrin
Monday October 27, 2003
The leader of Britain's doctors warned yesterday that the government is
creating a two-tier NHS where getting high-quality treatment will depend more
on luck than clinical need. James Johnson, who chairs the British Medical
Association, said ministers were in danger of destroying the character of the
health service in their zeal for promoting patient choice and hitting
political targets. John Carvel, social affairs editor
Monday April 19, 2004 The Guardian
NHS leaders have begged the main political parties to resist the
temptation to launch "headline grabbing initiatives" without involving
healthcare staff, as the prime minister and Conservative leader went head to
head over health policy today. The call came from Gill Morgan, chief executive
of the NHS Confederation, as she addressed health service managers at the
organisation's annual conference in Birmingham today. Tash Shifrin in
Birmingham
Wednesday June 23, 2004
A spate of primary care trust reorganisations is highlighting difficulties
in the progress of Labour's NHS reforms. Tash Shifrin investigates.
Wednesday August 25, 2004 The Guardian
Today the Labour conference turns its focus on to health. Successive Tory
leaders have taunted Labour for allegedly failing to restructure the NHS.
Nothing could be further from the truth. The challenge facing Labour is not
that it has done too little to change the NHS, but that it has done too much.
Multiple reforms are now bumping into each other, exposing goals which
ministers clearly wished to keep out of the spotlight. Malcolm Dean
Wednesday September 29, 2004 The Guardian
Paul Corrigan, the special adviser who made foundation hospitals a
reality, tells John Carvel what went right and what went wrong in his four
years at the health department.
Wednesday June 15, 2005 The Guardian
Doctors and nurses are threatening the success of NHS reforms, health
service managers heard today. Dame Gill Morgan, chief executive of managers'
organisation the NHS Confederation, told the confederation's annual conference
in Birmingham that frontline staff were not "fully engaged" with the
government's reform agenda, and could undermine overall success. Hélène
Mulholland in Birmingham
Wednesday June 15, 2005
The head of the NHS signalled plans today to reduce the number of primary
care trusts as part of an overhaul designed to improve the commissioning of
services. Speaking earlier this afternoon to NHS managers at the NHS
confederation's annual conference, Sir Nigel Crisp told delegates that poor
practice and governance in the NHS "can't go on" before going on to announce
the decision to streamline PCTs. Hélène Mulholland
Thursday June 16, 2005
One of the most striking features of the NHS today is the sheer volume of
reform. This includes one of the largest civilian IT projects ever, a new pay
framework for 1.2 million staff and new contracts for clinical professionals.
Market mechanisms have been introduced, including a system for paying
healthcare providers; independent sector providers have been introduced;
foundation trusts created; budgets for GPs developed; and policies to give
increased choice to patients. This in turn has spawned a large number of new
supporting policies and projects. Further reforms and a white paper on care
outside hospital are promised. The result is a highly complex architecture of
activity.
Wednesday June 15, 2005 The Guardian
Sick of NHS reforms. Letters
Wednesday
June 29, 2005 The Guardian
Existing health services are being deliberately destabilised to pave the way
for an ideologically driven privatisation programme. John Lister
Wednesday
July 20, 2005 The Guardian (recommended by
Keep our NHS Public)
Ask Kings Fund chief executive Niall Dickson to detail his hopes for the
next five years of NHS reforms, and he'll tell you a key ambition has already
been dashed. "I have lost this one right from the word go", says the head of
the health thinktank. "I would have said: 'Please do not do anymore major
reorganisation of health service', not because I believe the current
organisation is right, but because there is enough going on in the system as
it is". It was five summers ago that the government first published the NHS
bible of reform, the NHS Plan, and it will be another five years before the
job it outlines is completed. But only halfway through the reform agenda, the
government's insatiable appetite for moving deckchairs is testing NHS staff to
their limit. Hélène Mulholland
Thursday August 4, 2005 SocietyGuardian.co.uk
Patricia Hewitt, the health secretary, is facing a mutiny of NHS chief
executives over plans to rush through health service reorganisation. She
decided in July to accelerate plans for a wave of mergers among England's 303
primary care trusts, the bodies responsible for spending about £54bn a year on
commissioning care for NHS patients. John Carvel, social affairs editor
Thursday
September 8, 2005 The Guardian
As society becomes more complicated, politicians have to make things
simpler, says Paul Ormerod.
Friday
September 16, 2005 The Guardian
The government is planning to cut the number of ambulance trusts in
England by two thirds, it emerged today. Plans to reduce the number of trusts
from 31 to 11 by next April are to be consulted on from the end of next week.
The Department of Health confirmed that it was proposing to cut the number of
ambulance trusts to 11, but stressed that there would be no reduction in
vehicles or frontline staff.
Thursday September 22, 2005
She promised she would be a listening health secretary and there are signs
that she already is. It is still too early to separate rhetoric from reality,
but where in her early days Patricia Hewitt was almost celebrating the
instability and uncertainty that the government's new market in health would
create, a more circumspect approach is emerging on some fronts.
Wednesday August 3, 2005 The Guardian
The latest round of NHS reorganisation involving primary care reform is
provoking opposition from unexpected quarters. John Carvel
Wednesday October 5, 2005 The Guardian
Manic marketisation is driving the NHS into cut-throat chaos. Considering
Tony Blair's disastrous record on health service reform, it's reasonable to
ask how safe it is in his hands. Polly Toynbee
Friday
October 7, 2005 The Guardian
Hospitals are being destabilised and emergency services could be put at
risk by the introduction of market pressures into the NHS, the health
service's spending watchdog warned last night. The Audit Commission said a new
system of payment by results - rewarding NHS trusts directly for every job
done - was so extreme that hospital departments could be forced to close. "The
level of risk inherent in the current policy ... is too great," it said.
John Carvel, social affairs editor
Tuesday
October 11, 2005 The Guardian
Tony Blair yesterday insisted that his "choice" agenda for the reform of
schools and hospitals will deliver better services - not just for the middle
classes but for poorer people who have been badly served in the past. He
brushed aside complaints by expert organisations and critics within the Labour
party's own ranks who have been warning that market-orientated reforms will
only widen the gap between rich and poor in the use of public services.
Michael White, political editor
Wednesday October 12, 2005 The Guardian
Choice for all users of the NHS is the only way to embed good practice,
says Julian Le Grand.
Wednesday
October 12, 2005 The Guardian
Too much, too often, too disruptive. Health service reform. Leader
Wednesday
October 12, 2005 The Guardian
A major shake-up of local health services due to come into force next year
is to go further than expected, it was revealed today. The country's 28
strategic health authorities have until tomorrow to submit plans for cutting
the number of primary care trusts (PCTs) as part of an overhaul announced by
the head of the NHS, Sir Nigel Crisp, in July. Hélène Mulholland
Thursday October 13, 2005
Forget the rhetoric - most people just want decent hospitals.
Friday
October 14, 2005 The Guardian
Doing the right thing - for a change. Simon Caulkin on why changemakers
who work from the top down are doomed to fail.
Sunday October 16, 2005 The Observer
Disruptive change. As social services bosses prepare to meet this week,
Ray Jones says progress in care for elderly and disabled people is threatened
by funding problems and the rapid pace of change.
Monday October 17, 2005
Veteran health service manager Ken Jarrold retires at the end of December,
but he is not going meekly. His
valedictory speech to the Institute of Health Management last week was a
powerful critique of the NHS under new Labour. Jarrold skewered Labour's
failings unerringly: policy incoherence, thoughtless structural change, and no
effective financial management. Most startling was his assessment of the
corrosive effect of targets: "There is bullying and harassment at all levels.
The drive to deliver has become, in some places, an opportunity for
inappropriate behaviour. Performance management is not a value-free zone."
Patrick Butler Wednesday
November 23, 2005 The Guardian
Why the NHS should apply the brakes. Leader
Saturday December 10, 2005 The Guardian
The health secretary, Patricia Hewitt, today rejected claims that the
government health reforms were the cause of the current debt crisis in the
NHS. Speaking at the London School of Economics this morning she said that the
government reforms were the solution to - not the cause of - NHS deficits.
Tuesday December 13, 2005
The NHS needs localisation, not regulated privatisation. Yet another
restructuring of healthcare will waste more billions if it is based on choice
rather than local service and control. Simon Jenkins
Wednesday
December 14, 2005 The Guardian
Government reforms incoherent, former head of Department of Health
strategy unit warns. Professor Chris Ham, who left the DoH last June, said
that health policy has veered into "incoherence" and reforms are dangerously
"out of sync" between provision and commissioning. He said it was not clear
whether the government was "willing to live with the consequences of the
creative destruction" it has unleashed on the NHS. He told the Healthcare
Financial Management Association conference that problems with commissioning
were being exacerbated by the reorganisation of commissioners and the rush to
push purchasing onto "at best luke-warm" GPs. Ham called for payment by
results to be restricted to "planned" care, with emergency care being
protected from the excesses of the market, to avoid elective care becoming the
"tail that wags the NHS dog." "Unplanned care requires networks, but how will
that be achieved as services are being fragmented ? Unplanned care should
involve choice, but within a network of providers commissioned on a block
contract," he said. Health Service Journal 15 December 2005
Nigel Edwards, policy director of the NHS Confederation, writes on the
shortcomings of markets in healthcare.
British Medical Journal 16 December 2005
Keep Our NHS Public press release, published on Medical News
Today, Medilexicon.com and
HospitalsWorldwide.com, says: "The introduction of
the market and payment by results is having a catastrophic effect on the
nation's access to health care. Patricia Hewitt needs to realise that her
reforms are the cause of the current crisis and not the solution."
Medical
News Today 18 December 2005
This rigid market model won't survive the real world. New Labour was right to
want diversity and choice in public services, but that has now turned into an
unworkable dogma. John Denham
Wednesday
December 21, 2005 The Guardian
Rethinking inconsistent hospital policies. Leader
Wednesday December 28, 2005 The Guardian
The NHS's year
for living dangerously. A Financial Times leader backs the government's
reforms, but says that for the NHS "2006 looks like a make or break year" and
"the reorganisation feels too much like rearranging the deckchairs on the
Titanic." The government must re-establish financial control, create a
regulatory system to oversee the new market and develop a failure regime to
cope with its consequences. Private sector providers need reassurance that
they are long-term "partners", the FT says. "As patient choice and payment by
results kick in, ministers and the department need not just to hold their
nerve, but to drive ahead with reform as some services close and others open."
The government's strategy "contains paradoxes - a requirement for co-operation
among healthcare providers along with a demand that for competition. But the
recent experience of Scotland, Wales and Northern Ireland - where just as much
extra money has been invested for even less apparent result - shows that just
pouring new wine (more money) into old bottles (an unreformed service) does
not work."
Summary by
Keep our NHS Public
of Financial Times 31 December 2005
Plans to revolutionise the way patients are admitted to hospital have been
attacked as 'Stalinist' by Britain's leading surgeon. Bernard Ribeiro,
president of the Royal College of Surgeons, said the system would destroy the
professionalism of the NHS and put people's care at risk. As the Health
Secretary, Patricia Hewitt, prepares to announce a choice for patients of up
to four hospitals to go to for treatment, Ribeiro warned that the
professionalism of doctors was being undermined by a target-led culture and
the government's 'choice' agenda. He singled out the new £64 million 'choose
and book' computer project which allows GPs to make an electronic booking for
patients when they need to be referred to a consultant. Jo Revill, health
editor
Sunday January 1, 2006 The Observer
Audit Commission head warning over private firms in NHS. James
Strachan, the outgoing chairman of the Audit Commission, has warned that moves
to out-source NHS work to private providers must be watched to prevent damage
to other hospital services. Someone within the health service should
scrutinise this, Strachan said: "Somebody should really assume responsibility
for making that mixed economy work effectively without in any way, for
example, just standing back and watching key parts of a hospital being farmed
out such that it makes it very difficult for its A&E department to run itself
because it's lost some of the underpinning surgical divisions which it needs
to function." He also said that the pace of reorganisation in the NHS should
slow down, that it is "nonsense" to say the public sector cannot be as
efficient as the private and that payment by results is "part but not whole
cause" of the current financial crisis. Summary by
Keep our NHS Public
of BBC Online 3
January 2006
Critics' fury
at truncated ambulance consultation. John Davies, vice-chairman of the
Stoke-on-Trent Health Scrutiny Committee has accused Staffordshire and
Shropshire SHA of "denying democracy and paying lip service to consultation"
over the merger of Staffordshire's ambulance service into a West Midlands
regional brigade. People will have just 20 minutes to voice their opposition
as the SHA is only holding four public meetings to discuss the reconfiguration
of PCTs and SHAs, as well as the ambulance merger. Staffordshire's ambulance
service saves more lives and reaches 999 calls quicker than any other force in
Britain.
Summary by
Keep our NHS Public
of
Stoke Sentinel 10 January 2006
Hewitt - "now is
the time to increase the pace of reform." In a speech to the NHS
Confederation Hewitt said the forthcoming white paper will aim to achieve
"more effective commissioning, partnership working between organisations,
managed competition and the freedom to innovate." She announced that a number
of key documents will be published in 2006 including system guidance and
requirements for 2006/ 07, to link
together the key elements of finance, delivery and reform; framework documents
on commissioning, the future of provider reform, and system governance and
management; and a framework for the future of payment by results.
Summary by
Keep our NHS Public
of
Department of Health 11 January 2006Patricia Hewitt's plans to save £250m on NHS administration are ill-judged
and a false economy, the Commons' health select committee says today in a
unanimous report, approved by its usually loyal Labour majority. It said the
health secretary planned to merge primary care trusts - the lower tier of NHS
management in England, responsible for spending 80% of the health service's
£76bn budget. The upheaval followed a reorganisation, three years ago, when
PCTs were established. It usually took three years for the benefits of any
reform to be realised and the distraction caused by the latest proposals was
"ill-judged in the extreme," the MPs said. John Carvel, social affairs editor
Wednesday January 11, 2006 The Guardian
Plans for
overhaul of NHS attacked by MPs. A survey by Unison has found that 72% of
Labour MPs oppose any move to break up primary care services.
Summary by
Keep our NHS Public
of Financial Times 11 January 2006
NHS reforms
attacked as clumsy and cavalier. The House of Commons health select
committee has savaged the government's restructuring of NHS trusts, which was
announced in a letter from Sir Nigel Crisp in July 2005 and is proceeding
apace. The committee said: "The cycle of perpetual change is ill-judged and
not conducive to the successful provision and improvement of health services.
Major restructuring should only be undertaken if there is an overwhelming
argument in its favour; in this case there is not." It said the previous
configuration of PCTs had not been given long enough: "Just as the benefits of
PCTs are about to be realised, the Government has decided to restructure
them." It described the changes as "clumsy and cavalier", saying that six
months after they were announced the policy is still unclear. The process has
reduced staff morale and risked the fragmentation of community services.
Making the announcement in July and allowing only 11 weeks to produce complex
proposals was "insufficient and flawed. As a result patients, local people,
NHS staff, other NHS organisations, MPs, councillors and other key
stakeholders have been unable to contribute meaningfully to the process." The
timing of the reorganisation made a mockery of Department of Health's
expensive consultation exercise over the future of care outside hospitals. The
committee criticised the government for instructing trusts to reduce provision
of services to a minimum, which would transfer hundreds of thousands of staff
to the private sector: "The department must more carefully consider the impact
of its proposals on its staff, which are its most valuable asset. Major
changes to the NHS have large costs and should not be embarked upon lightly."
Summary by
Keep our NHS Public
of The
Times 11 January 2006
NHS
representatives in Downing Street meeting. Certain NHS representatives
were called to Number 10 on Tuesday to inform Blair how health service reforms
were proceeding. NHS Alliance head Mike Dixon said: "He wanted to ask people
like ourselves what it's like on the frontline and are the current changes
going to work or not." Dixon told him the reforms were going in the right
direction but needed fine-tuning.
Summary by
Keep our NHS Public
of BBC Online 12 January 2006
GP budget snub
threat to NHS plan. GPs are proving slow to take on the responsibility of
commissioning under practice-based commissioning. Only a quarter of doctors
have so far opted to control the health budget for their patients. Dr Hamish
Meldrum, chairman of the British Medical Association's GPs committee, said:
"The problem is that the NHS is gripped by deficits and doctors understandably
do not want to take on budgets where cuts are being made."
Summary by
Keep our NHS Public
of BBC Online 12 January 2006
Doctors' chief
says health reforms are inevitable but warns on danger to patient care.
BMA chairman James Johnson criticised government reforms, saying there is no
standard data to judge the clinical quality of independent sector performance;
no level playing field under payment by results because the NHS is left with
the most complicated and expensive cases but paid the same per treatment as
the independent sector, which takes on the simple procedures; and no clarity
over how care would be delivered seamlessly as patients move between public
and private providers. He also said that the reorganisation of PCTs and SHAs
was proving a disaster as it was distracting managers. However, he believes
there is "no going back" on choice and the introduction of more providers into
healthcare.
Summary by
Keep our NHS Public
of Financial Times 12 January 2006
MPs on PCT
reform: 'clumsy, incoherent and ill-judged'. In its report on PCT reform
the Commons health select committee makes clear it does not accept the
government's claim that it has reversed its policy on provision announced in
July. The committee said it is "appalled at the lack of clarity" over whether
PCTs will be required to relinquish the provider role, and calls for an
immediate and unequivocal policy clarification. The committee also said it was
"extremely concerned" about the outsourcing of commissioning in Oxfordshire -
since put on hold - which it described as a "significant departure from
current policy". It said further consultation was "absolutely crucial" before
the government allowed any PCT to proceed down this route.
Summary by
Keep our NHS Public
of Health Service Journal 12 January 2006
Quality and
outcomes framework now a political football, GPs claim. The clinical
credibility of the quality and outcomes framework (QFO) has been brought into
question by the politically motivated inclusion of indicators such as an
obesity register. Some GPs say the QOF is being hijacked as a means of
collecting data for the Government, and that the emphasis on registers is
preparing the caseload for the entry of private providers.
Summary by
Keep our NHS Public
of
Doctor Update 13 January 2006
PCT reforms
were "mishandled". Patricia Hewitt has admitted that her department
"mishandled" its instruction that PCTs should reduce their role as a provider
of services to a minimum by 2008, following the scathing report by the Commons
health select committee this week. In a speech to the NHS Confederation she
appeared to endorse proposals by Tony Blair's health adviser Paul Corrigan
that patients should be given the power to demand that failing PCTs commission
services from new private sector and voluntary providers. Summary by
Keep our NHS Public
of
Public Finance 13 January 2006
Millions for
NHS pay, little for beds and operations. The Independent says: "The White
Paper is expected to usher in a wider range of providers - including private
health companies, pharmacies and health professionals - who can offer NHS
services closer to people's homes. If patients can get treatment for their
chronic condition from their local GP or privately run - but NHS-funded clinic
they are less likely to use expensively funded PFI hospitals. The measures are
designed to increase competition and drive change. As a result, some services
may falter and hospitals fail. The inevitable consequence is that turbulence
will increase." Summary by
Keep our NHS Public
of
Independent 18 January 2006
One in four
rally to halt ambulance merger. A quarter of the population of the
Staffordshire Moorlands have put their name to a 20,000-signature petition
urging the government not to merge Staffordshire Ambulance Service.
Summary by
Keep our NHS Public
of Stoke Sentinel 18 January 2006
Managers lay
the blame at door of government. Of the 117 NHS trust chief executives who
responded to a Health Service Journal survey, 66% said that the introduction
of the private sector had destabilised parts of the NHS. 84% agreed with the
statement that the government was trying to dodge its own culpability for the
financial problems by blaming it on a small number of poorly performing
trusts. More than two-thirds said the NHS would not be facing such severe
financial problems if it were not for "inflexible government targets". 99%
said that staff pay deals and the new doctors' contracts were not costed
effectively by the Department of Health. Only 39% believed that the calibre of
finance directors is a major factor. Meanwhile, King's Fund chief economist
John Appleby has said that some SHAs have heaped debts on particular trusts so
that deficits can be blamed on a few bad apples, rather than a systemic
failure. He said: "The reality is that most, if not all organisations are
suffering to some degree financially. If you have got 10 hospitals in an area
and they all have a deficit of £2m that could look worse than if you have two
with a £10m deficit each. It implies something about who is to blame. If you
have just a couple of hospitals with big deficits you can start to say it's
bad management. If every hospital had a deficit it would send out a different
message. The finger could start to point upwards in the system."
Summary by
Keep our NHS Public
of Health Service Journal 19 January 2006
Hewitt:
struggling trusts to get management 'reinforcements'. In an interview with
HSJ, Patricia Hewitt said "additional management resources" on top of the
turnaround teams will work alongside existing management in financially
struggling trusts. In areas such as Surrey and Sussex and Bedfordshire and
Hertfordshire the teams will focus not just on the current crisis but on the
"much bigger decisions that need to be made to deal with the systemic
problems". But in the HSJ survey only 13% of chief executives agreed that
turnaround teams would be an effective way of getting NHS finances back on
track. 38% said they were not confident of being able to end this financial
year in a better position than last year. Hewitt also said the healthcare
outside hospitals white paper will signal a "fundamental strategic shift" from
acute hospitals to community services. She used the example of "polyclinics"
in Germany, where consultants and GPs work side by side. A Department of
Health source said: "The era of big hospital building programmes is over and
we will be shifting to care closer to where people live and work."
Summary by
Keep our NHS Public
of Health Service Journal 19 January 2006
Patricia
Hewitt: The NHS is back in business. Writing in the Independent in defence
of the government's health reforms, Patricia Hewitt claims: "We've used
independent treatment centres to slash waiting lists for routine operations
such as cataracts. We've introduced a choice of four hospitals for patients
being referred for elective surgery. By introducing Payment by Results (PbR)
and a new tariff of NHS costs, we can for the first time see what things cost
in the NHS, and plan more efficiently." She also says that the forthcoming
white paper will address the inverse care law and that "within two years, we
will have brought NHS finances back into balance."
Summary by
Keep our NHS Public
of
Independent 19 January 2006
Open for
business: how private provision is bringing an agony of choice in the NHS.
Nicholas Timmins points out that Sir Nigel Crisp may be the first and the last
person to simultaneously hold the jobs of NHS chief executive and permanent
secretary to the Department of Health because "there will not be a national
health service to be chief executive of - or at least not as we know it." The
envisaged market in provision will leave the NHS as a commissioner of services,
but even this is fracturing due to GP commissioning. Consequently government
decisions on regulation, currently the subject of an extensive review, will
"shape the future of healthcare provision in the UK." The chairman of the
Healthcare Commission, Sir Ian Kennedy, says: "We need the blueprint before we
build the building," as a poor regulatory system could drive the NHS into
greater levels of competition than the government intends, with little control
over quality.
Summary by Keep our NHS Public
of Financial Times 23 January 2005
PCT
consultations a sham - Gummer. John Gummer, Conservative MP for Suffolk
Coastal, has declared the consultation over PCT mergers a "sham". He also
claimed the health funding formula hit Suffolk, leading to rural areas with
large numbers of older people suffering from the effects of deficits. In a
House of Commons debate shadow health minister Stephen O'Brien said the
government's U-turn on its requirement for PCTs to divest themselves of their
role as providers meant that the reorganisation had lost its rationale: "How
can there be any sense in the Government proposing changes to the structure of
primary care trusts unless they first establish with clarity what the future
functions of the PCTs are to be ?"
Summary by Keep our NHS Public
of East Anglian Daily Times 9 February 2006
Health
ministers warned to keep careful watch on pace of reforms. Sir Michael
Lyons, acting chairman of the Audit Commission, has warned the government that
it needs to be careful about the pace of NHS reform. He said: "All these
tensions we are looking at have emerged before payment by results, more
contestability and more patient choice have taken full effect, and before the
full effects of Agenda for Change…We are demanding some pretty rapid and
dramatic changes. The commission's view is we need to be careful with this.
There is a need to keep an eye on the whole system and watch carefully the
pace at which these changes are being assimilated." He called for a better
system to spot and deal with financial and service failure early: "the notion
that we are going to have a whole set of hospitals going into financial
receivership doesn't seem to me a very credible model, or one that anyone
would want to sign up for." The FT says the Department of Health is seeking to
change the NHS accounting system from one where trusts have a statutory duty
to break even ever year to the regime used for foundation trusts. Sir Michael
Lyons said this would be "a pretty profound change" that in the short term
would be "painful" for the NHS. It would depend on having "the right skills on
the boards of organisations to ask the right questions" and "whether you have
information that you can rely on. On each of these fronts we have reasons for
anxiety."
Summary by Keep our NHS Public
of
Financial Times 9 February 2006
PCT leaders'
careers put on the line. Strategic health authorities were last week
warning PCT chief executives that their ability to show an improved position
would "affect their application process" for jobs in restructured PCTs later
this year. Managers' union Managers in Partnership condemned DoH and SHA
"bullying" tactics and said that "more people than ever" were now seeking a
"permanent exit strategy from the NHS". NHS Alliance chief executive Mike
Sobanja said: "Linking personal performance to the state of local health
economy finances…is disproportionate and inappropriate when a significant
proportion of deficits have been caused by ill-thought-out and poorly costed
central initiatives."
Summary by
Keep our NHS Public
of Health Service Journal 2 March 2006
Labour's flagship
health service reforms were in disarray last night, as the head of the NHS,
Sir Nigel Crisp, quit in the face of increasing deficits which the government
admitted would breach its forecast of £200m. Patrick Wintour and Sarah
Boseley
Wednesday March 8, 2006 The Guardian
The impossible job. Leader
Wednesday March 8, 2006 The Guardian
NHS chief axed
over hospitals' debt crisis. Secret government forecasts have revealed
that hospital deficits are likely to reach £900 million this year. One source
said that pressure from Downing Street had been "intense" over the past six
months after Crisp was told that Blair wanted to see results by April 2007.
Crisp said he had planned to stay for at least another year, and would have
preferred to go when the service was "on the up". Insiders linked the fresh
urgency from Downing Street to Paul Corrigan's appointment as Blair's health
adviser.
Summary by
Keep our NHS Public
of
Times 8 March 2006
Crisp and
uneven. A Times leader says that government reforms have "been rushed and
haphazard, producing unanticipated results and grotesque waste… It is
inescapable that Ms Hewitt is underperforming in one of the Cabinet's most
important posts. When the Prime Minister eventually reshuffles his team he
will have to confront the reality that the NHS is ailing. Sir Nigel is not the
only senior figure in the health sector who should be moving on."
Summary by
Keep our NHS Public
of
Times 8 March 2006
So Sir Nigel Crisp has gone, and
the Department of Health has been surprised by the size of the NHS financial
deficit (NHS
chief quits amid worsening cash crisis, March 8). No surprise though to
those of us working at the coalface of clinical-service delivery. Investment
in the NHS has never been so high, but staff morale is at an all-time low.
What has happened? The answer comes from a rapid, costly and expansive
programme of change, poorly thought out in the mistaken belief that fast
access to a high quality, comprehensive range of services can be delivered
within a fixed (and ever changing) budget. Change will not be effective where
there is centralised reform without the engagement of the bulk of the
workforce and pace of change exceeds pace of learning. Targets and performance
indicators have systematically bred mistrust, stifled innovation and have not
significantly delivered on health gain. But the greatest threat to the NHS is
not financial: it is the loss of goodwill among its employees. The NHS has
survived to date on the strength of goodwill among the workforce - who, by and
large, want to make a difference. The unrelenting whirlwind of change which
has barraged NHS employees over the last five years has left a workforce
demoralised, cynical and unengaged. The possibility of large scale
redundancies will only fuel this discontent.
Dr Les Ashton Leicester
You are correct to say that the
NHS is in no position to rollout payment by results in April (The
impossible job, leader, March 8). The financial chaos that has forced Sir
Nigel Crisp's resignation is in large part due to the cacophony of reforms
imposed upon the NHS to turn it into a market. The collision of unworkable
policies - as between payment by results and PFI hospitals, leaving the latter
in a wreck - displays the incoherence at the
DoH.
We need an urgent moratorium and a proper analysis of the evidence before
further damage is done.
Alex Nunns
Keep Our NHS Public.
Letters
Thursday March 9, 2006 The Guardian
Time to pay attention. Leader
Thursday March 9, 2006 The Guardian
NHS financial
ills take toll on jobs and services. As more NHS cuts are made Sir Nigel
Crisp, in a list of his achievements, disclosed the NHS was "anticipated" to
have overspent by £789m at the end of his tenure, while £959m of capital
expenditure, almost 10% of the planned capital spending over five years, had
not been used. The two figures combined mean the NHS is almost £1.75bn out on
its financial plans. Unison called for a slowdown on the introduction of
competition and private sector involvement in service delivery: "The
government must stop and take stock. We don't need this constant fog of reform
when it would make more sense to pilot changes to see what what works and what
doesn't."
Summary by
Keep our NHS Public
of Financial
Times 9 March 2006
Cash crisis is
slowing down reform, Hewitt admits. Progress on primary care reform
outlined in the white paper on out of hospital care has been hampered by the
financial crisis in the NHS, health secretary Patricia Hewitt has admitted.
Hewitt said any thoughts of setting specific targets for primary care trusts
on the shift from primary to secondary care, as suggested in the white paper,
had been put on the back burner.
Summary by
Keep our NHS Public
of Health Service Journal 9 March 2006
Warner: win
over MPs. Health minister Lord Warner has said MPs must be educated about
the thinking behind service redesign if plans for controversial NHS
reconfigurations are to get the green light. He said politicians would oppose
unpopular change in an attempt to win votes and avoid being 'Kidderminstered'.
Summary by
Keep our NHS Public
of Health Service Journal 9 March 2006
Scandal from
the back of an envelope. In an opinion piece Nigel Hawkes says that the
cost of PCT reconfiguration is a "scandal that has largely gone unreported".
He estimates that the creation and then merger of PCTs and SHAs has cost
£1.5bn. "They are now being merged into larger bodies, taking us back to more
or less where we started, while commissioning is being entrusted to GP
practices, an act of faith if ever there was one. Suffice it to say that this
new change is based on just as little evidence as at the invention of PCTs."
Summary by
Keep our NHS Public
of
Times 9 March 2006
MPs hear how
Labour's reforms are undermining the NHS. Royal Cornwall Hospital Trust -
which is to axe 300 jobs because of a £8.1 million funding shortfall - is
losing £6m of its income next year because of the government's use of
privately-run treatment centres. It will perform 6,000 fewer operations next
year with the patients being switched to ISTCs.
Summary by
Keep our NHS Public
of
Telegraph
10 March 2006
Crisp quits
amid 'confusion' at the top of DoH. Sir Nigel Crisp's resignation followed
a breakdown in relations between ministers and senior civil servants. A review
of the DoH's top management by consultancy McKinsey late last year - released
under the freedom of information act - warned that the working relationship
between ministers and official was not "fit for purpose" and that formal
meetings between them were too infrequent. A source DoH's senior management
said that behind the recommendations lay a department in which senior
officials were routinely undermined by ministers and special advisers. The
source said that "poor relationships" resulted in confusion. "One part of the
department would go out and announce: 'This is what we're going to do', while
another part would have no knowledge of what was being announced."
Summary by
Keep our NHS Public
of
Public Finance 10 March 2006
The only cure for the NHS is full independence. Leader
Sunday March 12, 2006 The Observer
Ambulance chief
quits over merger. Roger Thayne, head of the Staffordshire Ambulance
Service, has resigned following a row over planned mergers.
Summary by
Keep our NHS Public
of
BBC Online 17 March 2006
In her first major interview as health secretary Patricia Hewitt declared
nine months ago that instability within the NHS was "not only inevitable but
essential". Some NHS units would be closed but healthcare would benefit from
"a little bit of pain". There has been no lack of that in the past three
months as the depths of this year's deficits became clearer. Leader
Saturday
March 25, 2006 The Guardian
Former Health Secretary Frank Dobson will support calls for the Government
to suspend the next steps in its NHS reforms because of fears that they will
worsen the service's financial problems. Mr Dobson will tell a conference in
London that the main cause of the job losses and other cuts was the latest
round of re-organisation.
Saturday March 25, 2006 7:38 AM
. Press release from
Keep our NHS Public
25 March 2006
Our crusade to
save the NHS. The Express has launched a 'Save Our NHS' crusade, saying
"the NHS is the envy of the world and the jewel in the crown of our nation's
public services...It has been hit by crisis after crisis as it is run down by
a series of shambolic government policies."
Summary by
Keep our NHS Public
of Express 26 March 2006
A perfect storm
may make the NHS a lightning rod. Polly Toynbee writes: "Expect tales of
its failures to reach megaphone levels now Tony Blair has pinned his departure
day to the success of his latest, most radical reforms. Ahead lies a
frighteningly critical year. Payment by results with money following the
patient, goes live next week, a kill or cure shock treatment… Tony Blair has
already re-organised the NHS three times: this fourth attempt now puts back
and sharpens the Tory internal market he dismantled."
Summary by
Keep our NHS Public
of
Guardian
28 March 2006
The NHS needs a break from further reform. Letters
Thursday
March 30, 2006 The Guardian In one letter Dr Wendy Savage writes: "The
government needs to stop its endless, ill thought out reforms and allow things
to settle. With the Gatt agreements due to come into operation at the end of
this year, ISTCs will never be able to be returned to the NHS and no more of
these should be created, with primary care trusts locked into expensive
contracts for years. A proper debate is needed about whether or not people
want their NHS privatised. This is being done by stealth, cloaked by the
rhetoric of choice and 'a patient-led NHS'."
Summary by
Keep our NHS Public
We are all
paying the penalty for NHS paper chase. In a reprint of his speech to the
NHS SOS conference, organised by Keep Our NHS Public and the NHS Support
Federation, former health secretary Frank Dobson says: "People are asking why
our hospitals are running up huge debts when the NHS has been given extra
money. The main explanation is that so much money is being gobbled up by the
'reforms' that Ministers have promoted."
Summary by
Keep our NHS Public
of
Yorkshire Post 30 March 2006
Stop the 'NHS
experiment - people's health is at stake'. The Government should suspend
the next steps of its NHS reform programme and return to a dedicated focus on
patient health, according to former health secretary Frank Dobson. He said any
extension of the current NHS reforms will cause more financial problems and
lead to thousands more job losses: "The payment by results experiment
threatened from 1 April is just that - an experiment. The NHS is too important
to be experimented on - people's health is at stake." Alex Nunns of the Keep
Our NHS Public campaign said: "There is now widespread concern, from the
unions to the Audit Commission, that this big bang approach to health service
reform is too fast and too dangerous. Already we are seeing NHS managers
citing payment by results as the reason for cuts. It's driving PFI hospitals
to the point of insolvency and rows are breaking out between trusts and
hospitals over bills."
Summary by
Keep our NHS Public
of
24dash.com 31 March 2006
Hospital and
ward closures predicted. The NHS Confederation, which represents PCT chief
executives, has said that hospitals and wards might have to close quickly if
the National Health Service is to regain financial balance and meet the target
of a maximum wait of 18 weeks for all treatments.
Summary by
Keep our NHS Public
of
Financial Times 1 April 2006
The business leader who convinced Gordon Brown to pour more than £40bn
into the NHS has issued a scathing rebuke over the government's failure to
deliver genuinely radical improvements to patient care. In his first open
criticism over the handling of the record investment in the health service,
Sir Derek Wanless blamed generous increases in pay for doctors and nurses for
the financial crisis now facing many hospitals. His attack came as the
official [Andrew Foster] responsible for implementing the pay deals prepared
to leave the Department of Health, just a month after the departure of its
chief executive Sir Nigel Crisp. Ned Temko and Jo Revill
Sunday April 2, 2006 The Observer
Real reform of
health service 'a deceit'. Professor Aidan Halligan, former deputy chief
medical officer, now director of clinical governance for the NHS, has said:
"Any suggestion of real reform has been a deceit. Working patterns, practice
and custom are at the heart of many capacity issues and have never been
challenged". Targets have become "an end rather than a means and, together
with blinkered performance management, have distorted health care priorities
and prompted initiatives built on little clinical understanding and massive
over-management". In remarks apparently aimed at Nigel Crisp and Patricia
Hewitt, Halligan said the NHS was suffering "a leadership void which has
caused it to lose its way". The service was "rudderless at the moment . . . it
is extraordinary the gap between highly motivated frontline staff and the
systemic dysfunctionality in which they operate".
Summary by
Keep our NHS Public
of
Financial Times 3 April 2006
The financial crisis in the NHS forced a
Cornish hospital to divert patients 35 miles for emergency services over
the weekend, because the trust could not afford a locum to cover for a
casualty doctor who was off ill. West Cornwall hospital in Penzance has a £9m
deficit, and decided not to replace the duty doctor when he called in sick on
Friday. Ambulance crews were told to take seriously ill patients to another
hospital 35 miles away at Treliske, Truro. Sandra Laville
Monday April 3, 2006 The Guardian
Health staff
find ward padlocked. Ward 10 at Hull Royal Infirmary was unexpectedly
closed at the weekend, and now managers at the
Hull and East Yorkshire Hospitals NHS Trust cannot guarantee its future.
But the ward was reopened on Monday due to a shortage of beds elsewhere in the
hospital. The ward, which has 26 beds, treats mainly elderly people with a
range of medical conditions. The trust admitted current financial troubles
meant there were not enough nurses to staff it safely. It is £12.6m in the
red, and has introduced several cost-cutting measures, including shedding 300
jobs over the next two years. One nurse said: "I went to work and found chains
on the door. We were not informed the ward would be closed. We were told to
report to a different ward to see where we would be working. It's not good
enough. Patients and their families must have been distressed. I think it's
disgusting the way the trust has treated staff and patients."
Summary by
Keep our NHS Public
of Hull Daily Mail 3 April 2006
Morale among
healthcare staff is at an all time low. Staff morale at
Leicester's two PCTs is amongst the lowest in the country, according to a
Healthcare Commission report. Staff face uncertainty over the future of jobs
and services.
Summary by
Keep our NHS Public
of Leicester Mercury 3 April 2006
Out-of-hours
cash crisis set to force GPs into opting out. More than 500 GPs who chose
to provide out-of-hours services under the
new contract are considering
opting out because of worsening NHS funding problems. PCTs in south-east
London have withdrawn £1m of funding from local GP co-op Seldoc, forcing
it to hike charges by 50% from 1 July. The co-op has written to GPs asking
them to consider whether it would be more economic to opt out of the scheme.
Summary by
Keep our NHS Public
of Pulse 3 April 2006
Call for NHS
demo gets support. There was a call for a national demonstration in
defence of the NHS at a Keep Our NHS Public conference on 25 March. Originally
there was only one resolution to be voted on, a simple pledge to carry on
fighting, developing local campaigns and lobbying our MPs. Then an amendment
was moved from the floor calling on the campaign to get the TUC to organise
such a demonstration, and was carried.
Summary by
Keep our NHS Public
of
Pulse 3 April 2006
Two years left
'to save free NHS'. There are just two years left to save a universally
free NHS, and patients can expect to see beds closed, services reorganised and
hospitals shut as reforms begin to bite and managers try to do more for less,
doctors' leaders are warning. Chairman of the BMA James Johnson said: "After
five years of 7% growth per annum
the NHS is in a bit of a mess. We only have another two years left and after
that we will go back to growth levels of 2-3%. What we believe in most of all
is an NHS free at the point of use.
If we want that to continue we have probably got two years to get that right."
Former government health adviser Chris Ham said politicians are on a "journey
of creative destruction". He said there was an element of deliberately taking
risks and "destroying the old ossified features of health care".
ISTCs and the
increasing amount of health care provided by the
private sector was
leading to surplus capacity, meaning hospitals either competing aggressively
to fill their beds or
taking a decision to close them and
cut costs. As the
reform process continued, there would be "mergers and acquisitions" with one
hospital taking over another as health care providers sought to protect their
position. But he said there would come a point where politicians found it
difficult to live with the consequences of the reform process they had begun.
Summary by
Keep our NHS Public
of BBC
Online 4 April 2006
Hewitt walks
tightrope with 'rebalancing' act. In a letter to the FT, Alex Nunns of
Keep our NHS Public
writes:
"Patricia Hewitt refers to the loss of thousands of NHS jobs as a 'rebalancing
of staff', made necessary by new technology and better ways of treating
patients at home. Why, then, are NHS managers citing market reforms as the
reason for cuts ? Mrs Hewitt says
the current reforms are 'part of the solution, not part of the problem'. But
the
County Durham and Darlington hospitals trust recently announced that 700
staff are to be 'rebalanced' because of the payment by results system and the
effects of
contracted private treatment centres."
Summary by
Keep our NHS Public
of
Financial Times 4 April 2006
Blair is
accused of wrecking NHS with confused policies. The former chairman of the
University Hospital of North
Staffordshire, the hospital forced to sack 1,000 staff due to its £15.5m
debt, has accused the Government of wrecking the NHS with bureaucracy and
contradictory policies. Calum Paton said Tony Blair had "snatched defeat from
the jaws of victory" on state-funded health. He said the Prime Minister had
"not a hope in hell" of achieving his stated aim of a maximum 18 weeks between
a patient's first GP visit and having an operation. He said: "The Government
has suffered from drastic policy confusion and what I call initiativeitis,
bringing out up to three initiatives a day that cost a fortune to run."
Encouraging Trusts to work independently to promote choice but at the same
time telling them to promote local collaboration had caused confusion. SHAs
"crawl to ministers and refuse to tell them the full extent of the
financial crisis".
He slammed patient choice,
saying "patients in Staffordshire don't want a bus trip around the country to
go to hospital, they want good local services. If the Government had taken a
harder look at strategy at the outset it could have spent the same and got
much better health care."
Summary by
Keep our NHS Public
of
Telegraph 5 April 2006
Warning over NHS
hospital closures. At a BMA conference Chris Ham, former head of the
Department of Health's strategy unit, has said he doubts about whether
politicians and health ministers "will be prepared to live with the
consequences" of the "creative destruction" and closure of hospitals that will
accompany the government's reforms. He said: "My guess is that they won't."
The 2001 election result in Kidderminster is "en-graved on politicians'
minds," he said. Chair of the BMA James Johnson said doctors were sharply
divided over the merits of the government's reforms. Some would fight them.
But he, alongside Dr Hamish Meldrum, chairman of the BMA's GPs committee and
Dr Jonathan Fielden, deputy chairmanof the consultants' committee, all
acknowledged that the way hospital services were provided needed to change.
Summary by
Keep our NHS Public
of
Financial Times 5 April 2006Doctors must help in fight for NHS.
Letters
Thursday April 6, 2006 The Guardian [refers to and opposes a
proposal
from a group of doctors for charging]
Cost and
consultants in the NHS. In a letter to the Times, Dr Chris Laing writes:
"There is justifiable concern about where the large
increases in NHS funding has been
going. This has been met with rather cynical briefing that it "has all gone on
pay rises". This is preferable to the wastage being
pinned on government initiatives, such as £5 billion for "choose
and book". It is frequently stated that spending has gone awry because of
a lack of reform. This "reform" has transformed the world's most efficient
health service to one of the most inefficient. It has transferred huge amounts
of public money into the coffers of management consultants, contract lawyers,
IT firms, private
healthcare companies and
PFI builders and
left a mounting bureaucratic burden. Perhaps a little less reform would be in
order ?"
Summary by
Keep our NHS Public
of
Times 6 April 2006
Blair warned on
effects of 'biting' health reforms. The government has unveiled plans to
reduce the number of SHAs from 28 to 10, a move it said would save money by
cutting bureaucracy. Niall Dickson, chief executive of the King's Fund
charity, said: "This is the right policy at the wrong time. Redrawing the
boundaries of the NHS like a 19th century imperial power is not and never will
be a panacea for the health service, and this reorganisation - the latest in a
very long line - has simply thrown the NHS into even greater turmoil."
Summary by
Keep our NHS Public
of
Financial Times 13 April 2006
An unhealthy
approach. An Independent leader says: "The Health Secretary, Patricia
Hewitt, tried to play down concerns about the situation and
distract attention with the announcement of a
reorganisation of Strategic Health Authorities in England. Yet her argument
that the NHS budget
deficit is not all that serious - and that only a small number of NHS
trusts are affected - simply does not wash."
Summary by
Keep our NHS Public
of
Independent 13 April 2006
Rationing the
health service. In a letter to the Times, Chairman of the BMA James
Johnson writes: "referral
management centres are completely at variance with the Government's
patient choice policy (letters,
April 11 and 12). These initiatives erect a barrier
between the doctor who has seen the patient, usually the GP, and the
consultant best placed to look after the patient's needs."
Summary by
Keep our NHS Public
of Times 13 April 2006
Right goals, too many wrong results. Leader
Wednesday April 19, 2006 The Guardian
Children with cancer
and leukaemia are among the frontline victims of sweeping cuts being forced
through to contain the health service's ballooning
financial deficits,
nurses' leaders warned last night. The
elderly and those with
mental health problems are also suffering, with the closure of beds in
community hospitals and the reduction in numbers of
specialist nurses needed to treat
them. Nurses' leaders yesterday published a dossier of examples to back their
claims and said their research disproved ministers' assertions that trusts are
seeking to balance their books without any detriment to patient care. The
warning came as Patricia Hewitt, the health secretary, came under widespread
attack for
claiming yesterday that the NHS had just enjoyed its "best year ever". In
a speech to Unison's health conference in Gateshead today, Ms Hewitt is
expected to offer a stark message that the NHS must "modernise
or die". As part of a coordinated fightback she will say that, after the
additional resources put into the service by Labour over the past few years,
the NHS was now "back in business". Beverly Malone, general secretary of the
Royal College of Nursing, roundly denounced Ms Hewitt, saying that if this was
the best year for the NHS she dreaded to think what a worse one could be like.
Drawing from RCN research, she gave examples of how patient care was being
affected in second tier services for the vulnerable. Among the examples were:
- Children with cancer and leukaemia in Taunton,
Somerset, are no longer being treated by a community nurse because the
local primary care trust withdrew funding it had promised to the
cancer charity
CLIC. The children now have to make long journeys for treatment, wrecking
their chances of continuing a normal life in their own community.
-
Avon and Wiltshire mental health trust has cut the number of beds by more
than 65 to less than 40. The frail and vulnerable have to go further afield
for treatment.
- In the
Cotswolds, 80 community beds have been closed within the last three months
to reduce deficits. A similar number have been lost in
Felixstowe.
- Ward closures in
Skegness has led to patients having to travel 40 miles to Lincoln.
- Minor injuries units are being closed and opening hours reduced.
Dr Malone said: "NHS deficits are hitting patient services; to claim
otherwise is simply wrong. These are real services for real people with real
illnesses, and we have got to stop treating them as statistics on a balance
sheet." Yesterday it emerged that Downing Street received a report from his
delivery unit last week pointing out that prospects for reaching 11 of the
government's 28
health
targets by 2008 were poor. The Department of Health declined to name the
11 targets that received "red traffic lights", but it was understood they
included public health
objectives such as improved sexual health and reduced children's obesity. John
Carvel and Tania Branigan
Monday
April 24, 2006 The Guardian
Health Secretary Patricia Hewitt will face warnings of possible
industrial action over
job losses in NHS
hospitals. Addressing the health workers' conference of public service union
Unison in Gateshead, Ms Hewitt will urge NHS staff to back the Government's
reforms of health provision, warning that the service must "modernise or die".
But Unison general secretary Dave Prentis will tell her the NHS is being
destabilised by "disastrous" job cuts fuelled by
Government policies. He will warn Ms Hewitt that his union is gearing up for
industrial action to fight job losses, protect patients and challenge reforms
that are "fragmenting" the NHS.
Monday
April 24, 2006 9:03 AM
Blair signals
further NHS job losses.
Further job losses and ward closures might be the inevitable price of reforms
that would ultimately transform the health care system, Tony Blair has
suggested. Blair argued that recent job losses at some trusts were not
necessarily a bad thing, saying it depended on the underlying reason for the
job losses. The reforms that were being implemented would affect the volume of
work given to certain hospitals, he suggested, as more health care was
undertaken locally and operations were allocated on the basis of cost
effectiveness. The latest NHS
workforce figures were cited by Blair as evidence of a larger workforce,
but they also showed that the number of NHS managers has almost doubled over
the past decade [initiative overload], from
20,842 in 1995 to 39,391 last year. This means the number of managers has
risen twice as fast as that of doctors and nurses.
Summary by
Keep our NHS Public
of
Financial Times 25 April 2006
Stop wailing
about the health service. An opinion piece by Philip Stephens says: "In
the pre-Thatcherite world inhabited by the media… news that the NHS is
shedding thousands of staff is proof positive that the country's most revered
institution is in terminal decline. In fact, the squeeze is a sign reforms may
be working."
Summary by
Keep our NHS Public
of
Financial Times 25 April 2006
The costs of
revolution. Writing in the Guardian, James Johnson, chairman of the BMA,
says: "The political need to demonstrate a return on investment has resulted
in ever faster reform in order to show results. Each administrative change has
a cost that is rarely
clawed back through subsequent attempts to create efficiencies, and
changes are rarely given time to bed in… What is the financial cost of all
this change ? The short answer is
that we don't know, exactly: change tends to be introduced without its impact
and value for money being rigorously evaluated… A fear for many is that the
competitive environment of
payment by results
will fragment care and damage collaboration. And pressure for structural
change such as mergers and closures of institutions will continue while
market pressures will
increase… Relentless, rapid, poorly coordinated
initiatives that fail to involve doctors and patients are damaging and
costly."
Summary by
Keep our NHS Public
of
Guardian 27 April 2006
'Consensus on
the reform agenda has broken down'. In an outspoken interview outgoing DoH
workforce director Andrew Foster has said that the widespread consensus around
the NHS Plan has been broken down by the shift in policy towards market
reforms. He said he attempted to use his influence to rescue the once-prized
consensus between government, unions and professional organisations after it
came under threat during the regime of former health secretary John Reid. He
said: "The NHS plan was the product of a fantastic consultation exercise with
everybody involved, and everybody recognised their contribution in the
finished policies. When John Reid came in we produced a series of major policy
changes without consulting people, without even sharing them at draft stage.
We produced a series of major policy documents - Shifting the Balance of
Power, Creating a Patient-led NHS - and just sprung them on an unsuspecting
NHS in 2004-05. It's not surprising, therefore, that they didn't feel the same
level of ownership." He says "the biggest shock to the system" - Commissioning
a Patient-led NHS - was produced "by a very small group of very senior
people", so it "came as a huge surprise to a lot of senior people" as well as
to the NHS. He says that in the DoH he has voiced staff anger at the change in
direction of policy: "It's very clear to me that there is a long way yet to go
to build up a coalition of hearts and minds behind that reform programme." The
NHS Plan "is no longer the blueprint for the NHS. What has really emerged over
the last two to three years is that the vision, and it's a prime ministerial
vision of all public services, is one where you create a self-improving system
by using a mechanism of markets that apply to the public sector and so you
introduce a standard price, choice for patients, you introduce plurality of
provision, including private providers. None of that was in the NHS plan… It's
been almost tangible over the last 15 months, the growing sense of
dislocation between the NHS and the DoH and a
growing lack of confidence in the leadership of the department. We were in bit
of denial for a long time. We kept saying: 'There aren't any real problems and
insofar as there are they're your fault NHS, you're badly managing your
resources.' Now that is a completely unrealistic approach to take and made the
problem worse in my view." He says there has been a "bursting of the gates"
over the last couple of months, but acting NHS chief executive Sir Ian
Carruthers is creating a "definite sea change" in the atmosphere in the DoH.
Summary by
Keep our NHS Public
of Health Service Journal 27 April 2006
Creative
destruction in the NHS. Former government adviser Chris Ham writes that:
"When the prime minister makes two major interventions
in the NHS in the space of a week, it is a sure sign that the problems of the
NHS have reached the top of the government's agenda… The crunch point has
arisen, in his words, as part of the transition from the application of
'necessarily crude and blunt instruments of centralised performance management
and targets'
to the use of market-like
incentives 'to make reform self sustaining.'" Summary by
Keep our NHS Public
of
British Medical Journal 28 April 2006
Doubts on White
Paper's pledges. Dr Hamish Meldrum, GPC chair, has cast doubt on the
government's ability to bring in flagship elements of its recent Our Health,
Our Care, Our Say White Paper. He said it was still unclear what
funding was
available for the initiatives. He warned that even
with the money, the plans were still "challenging" to bring to fruition. The
DoH had not given any 'serious thought' to the ability of patients to receive
a home visit if they were registered near their workplace, Dr Meldrum said. He
added it was also unclear how many practices were expected to extend opening
hours or whether practices with extended opening hours would be expected to
provide a full range of services or emergency care.
Summary by
Keep our NHS Public
of Pulse 28 April 2006
Hospitals
told to embrace reforms. Health
minister Lord Warner has said local hospitals risk becoming "unpopular,
unsustainable and
probably unsafe" if they do not adapt to the government's NHS reforms. He said
hospitals will need to change care is moved out of hospitals, new
independent sector
providers enter the market, and more hospitals move to
foundation trust status.
These reforms mean local hospitals have to "face up to the need to reconfigure
services". The position of "the most financially challenged hospitals" raised
questions "about the way their services are configured" and not just about
their financial management. He said "it is down to trusts, boards, clinicians
and managers locally to face up to the changes that are needed", which "cannot
be driven from the Department of Health in Whitehall".
Summary by
Keep our NHS Public
of
Financial Times 2
May 2006
The politics
column - Allyson Pollock. In the New Statesman's main political column,
Allyson Pollock writes: "According to Patricia Hewitt the NHS has had its best
year ever. So why is the Royal College of Nursing threatening industrial
action over cuts
and
closures, and why did the annual conference of Unison, traditional Labour
supporters, greet the secretary of state with heckling?
In her words, "the NHS must modernise or die". So
why, from
Surrey to
Manchester and from
Gateshead to
Shropshire, are local people banding into hospital action groups and "Keep
our NHS public" campaigns in an effort to defend the health service
? The chief targets for cuts are
mental health services, palliative care,
older people's care and emergency hospital care, yet Hewitt maintains, to
general derision, that quality will not be affected…
Pay accounts for 60-70 per cent of
NHS hospital budgets, but pay awards accounted for less than 30 per cent of
the new money and should have been absorbed easily. Nor was greed involved;
the increases returned NHS pay to previous levels after years of pay freezes.
The hourly rate of the lowest-paid rose initially from £5.16 to £5.67 an hour;
medical consultants got increases of 4-5 per cent a year, taking them to
averages of between £75,000 and £95,000, while managers - their numbers
swollen by the complications of marketisation - got 7.5 per cent more last
year. The real reason for the decision to axe in excess of 13,000 clinical
staff and 1,000 NHS beds, plus associated services, is
market-oriented
reforms such as "choose and book",
"payment by results"
and foundation hospitals.
Hospitals and services are required to behave like stand-alone companies,
competing with each other and private corporations for income and patients…
The government plans to hand over most of the NHS budget to the private sector
through "practice-based commissioning". Under this policy, local PCTs will
eventually contract with for-profit companies such as the US-owned
UnitedHealth Europe to provide GP services… The Prime Minister asserts that
the reforms are bearing fruit, and so they are - for "investors" such as the
lucky shareholders of
Norfolk and Norwich and
Bromley PFI
hospitals, who received a windfall of more than £500m within months of the new
hospitals opening. But the PFI has been less "fruitful" for local people, who
have seen a quarter of beds closed and clinical staff and community provision
cut. A large part of hospital trust deficits is due to PFI debts, running at
£1.5bn a year… And then there are the costs associated with establishing and
operating a market - costs the NHS was explicitly designed to avoid: these are
for invoicing, marketing, advertising, drawing up hundreds of thousands of
contracts, legal disputes with contractors and rival hospitals, and using
management consultants… And though NHS hospitals remain responsible for
balancing their books, the government has ensured that the only way they can
do so is by cuts, closures, the sale of land and buildings - and more
privatisation. Some foundation trusts are entering joint ventures with
companies such as the Hospital Corporation of America, providing care to
private patients in what were previously NHS beds. Others are
charging NHS patients for "extra"
care: Queen Charlotte's and Chelsea NHS hospital has introduced a fee of
£4,000 for one-to-one midwife care - once the NHS standard - and the
government is allowing it. The less fortunate hospitals - if that is the right
word - are closing services and sacking staff. Is this what the English
patient needs or wants ?"
Summary by
Keep our NHS Public
of
New Statesman 2 May 2006
'Unpopular,
unsustainable' - that's Blair and his chums. In a letter to the FT John
Lister writes: "Like Patricia Hewitt, the health secretary, last week, Lord
Warner, the minister for National Health Service reform, is sadly out of touch
with the world around him: it is not local hospitals that are becoming
"unpopular and unsustainable" ("Hospitals told to embrace reforms", May 1) but
Tony Blair's government. While Labour faces a thrashing compounded by
hostility to its health reforms at the ballot box this week, and would
struggle to fill a single coach with unpaid supporters of its health policies,
the swiftest way to get thousands of local people almost anywhere in the
country out of their armchairs and into the streets in protest is to threaten
to close their local hospital. If Lord Warner really believes there is a
reservoir of public support for shutting down popular, busy local NHS general
hospitals to open up a space in a new healthcare market for unpopular,
half-used, profit-seeking private treatment centres, he is sadly deluded. And
while Lord Warner does not have to stand for election, few local Labour MPs
will relish the prospect of their seats going the way of
Wyre Forest, where voters took their revenge in the aftermath of the
closure of Kidderminster Hospital. "People are not stupid," says Lord Warner.
No, it is ministers who are stupid if they cannot see that the first step out
of a hole is to stop digging. They have convinced virtually nobody that their
plans are the right ones or that the extra billions for the NHS have been
wisely spent. The opposition to these plans is growing, and the biggest
battles are yet to come. If Mr Blair and his chums press ahead down this road
of "creative destruction" of the public sector in healthcare to facilitate the
pointless creation of a new, parasitic, private sector, they will pay a heavy
price."
Summary by
Keep our NHS Public
of
Financial Times 4 May 2006
What we in
Labour really fear now. Labour MP Diane Abbott writes: "In recent decades
the Labour Party has drawn its activist base disproportionately from the
public sector. Yet it is among public sector workers that scepticism about new
Labour's market-based reforms is strongest. No one is against change, as
Blair's acolytes like to claim. But people are entitled to be sceptical about
the fact that there are so many poorly managed private sector-style
initiatives (in health, for instance) at the same time."
Summary by
Keep our NHS Public
of Times
10 May 2006
The price of
everything. David Janner-Klausner argues that introducing a
market into local
health provision can in theory increase user 'choice'.
But in practice the most likely result is that a few giant firms will end up
running all the services in ever-larger areas. He writes: "There is a risk that
the mechanisms introduced to increase choice will
harm the very communities that
Le Grand
argues would benefit most from it. The point is not only to provide choice, but
also to understand the nature of it, including who the operators are, whom they
employ and whether the competition between them will be real…The reality will be
the emergence of a small number of suppliers, awarded ever-larger contracts. A
similar consolidation has taken place in the bus market following
deregulation…For smaller companies, training, innovation and participating in
bidding processes costs proportionately more than for larger ones. If they need
to invest to fulfil a contract, they are likely to be considered a risky
prospect by lenders because their income streams are not as diverse as those of
larger providers. If they are
charities,
their ability to assume risk is even more limited…if commissioners try to
include knowledge-sharing clauses in contracts, they are likely to find that
contractors put a price on sharing their intellectual property with competitors,
if they are willing to do so at all. This will make market-based provision more
expensive and will slow down innovation when the goal is to speed it up…Since
the government is committed to developing local markets, the likely outcome is
that larger companies will have the edge. Furthermore, commissioners will be
tempted to get together and offer larger contracts, as this can cut costs.
Smaller companies will lose out and agglomeration is almost inevitable. The
impact on costs and quality of outcomes is unclear to say the least.
Summary by
Keep our NHS Public
of
Public Finance 12 May 2006
Half-baked NHS
reforms could harm patients, says think-tank. A report by the King's Fund
says patients could suffer from reforms to introduce choice and competition in
the NHS unless the government gives a clearer commitment to establishing a
full-blown market for the supply of healthcare. The report accuses ministers of
sending mixed signals about their commitment to establishing a market among
healthcare suppliers, "one day implying they are in favour, another denying some
of the likely consequences". The report, drawn up by a group of senior
executives from the NHS, private and voluntary sectors, calls for a clearer
split between commissioning and supply, an overhaul of regulation including a
new competition body for healthcare, and no arbitrary limit to the role of
private or independent providers. The report concludes that without an
unequivocal commitment to a market among suppliers, patients will not only fail
to win the full benefits of competition and innovation but could lose out if the
strengths of services such as emergency care are damaged by half-baked reforms.
It also calls for an overhaul of the regulation of healthcare suppliers with a
regime to deal with financial or clinical failure, to allow mergers and
acquisitions and maintain competition. The Department of Health should be split
into three separate bodies: a rump department overseeing the NHS budget and
general policy; a separate commissioner of services to buy care for patients;
and a separate entity overseeing NHS services, whose role would shrink over time
as NHS staff transferred to independent employers.
Summary by
Keep our NHS Public
of
Financial Times 5 June 2006
Admit NHS market,
ministers told. The government should come clean and admit it is creating a
market in the NHS, according to a King's Fund working group of NHS managers,
businessmen and voluntary sector officials. Group chairman Greg Parston said: "A
supply-side market is being created in healthcare out of a powerful mix of
tariffs, incentives and new providers. A poorly operating market could damage
widely acknowledged NHS strengths and ultimately undermine patient care." King's
Fund chief executive Niall Dickson said: "The move towards the introduction of a
supplier market has been achieved with surprisingly little serious discussion
and there is still some uncertainty about where it is all heading." The
Department of Health denies it is turning the NHS into a market.
Summary by
Keep our NHS Public
of BBC Online 5
June 2006
Government
reforms will 'destroy the NHS'. Speaking to the
annual BMA consultants' conference, Paul Miller, chairman of the consultants'
committee, said: "This has been the NHS's best year ever ... for management
consultants ... for losing staff ... for wasting money." He estimated that
private management
consultants were costing around £3bn a year and used the work of private
managers in Department of Health-appointed "turnaround teams" sent into 18
trusts with financial
difficulties as examples of wasted money. This included £700,000 paid to
management consultants for three months' work at Surrey
and Sussex trust, despite the fact it still finished the last financial year
with "an operating deficit of £28m and an accumulated deficit of over £57m".The
multi-billion pound contracts awarded to independent sector treatment centres
were also a waste of money, Dr Miller said. Calling for a moratorium on any
other private treatment contracts, he said Oxfordshire primary care trust had
been made to pay £500,000 a year for the next four years to a
private eye clinic
despite there being no shortage of NHS capacity to do the work. He said only 160
of the 400 operations planned in the contract annually were carried out last
year. This was unnecessarily inflating local NHS debt, which stands at around
£82m. Dr Miller also criticised the
PFI, highlighting
£130m wasted on three deals: the abandoned
Paddington PFI scheme, which cost £14.9m; the delayed Barts PFI scheme,
which cost an extra £35m; and the
Norfolk and Norwich PFI, under which the NHS missed out on £82m when the
private contractors refinanced the deal. "If you had made this up, you would be
laughed at," Dr Miller said. "If you were the one who did make this up, you
should be ashamed. If you continue to make it happen, you will destroy the NHS.
This is not the way to run our NHS… It is hard to avoid the conclusion that we
are working in a service which is being broken by policies which do not work;
devised by officials who have resigned; implemented by managers who don't
believe [in the NHS]; and
patients without a say." His speech, which got a standing ovation, was
echoed by criticism of the government made by delegates. A member of the BMA's
consultants committee, Dr Anna Athow, said the government had allowed the NHS to
get into the current financial crisis in order to ration services and push more
resources and patients into the private sector.
Summary by
Keep our NHS Public
of
Guardian 7 June 2006
Free NHS of
politics, says top doctor. Dr Paul Miller, chairman of the British Medical
Association consultants' committee, has said an independent body should run the
health service because the Government's health policies have failed. He said
there had been "shocking incompetence" at the top and "something is going badly
wrong". Miller accused the Government of wasting money on expensive
PFI schemes,
independent sector
treatment centres and unnecessary
private management
consultants. He said: "Care is suffering, jobs are disappearing, patients and
staff are paying the price. If a patient gets worse instead of better with
treatment, then it's time to figure out whether the diagnosis or the treatment
is wrong. Something is going very badly wrong with these health policies. It is
time to call a halt, examine what is not working and why." The deficits, he
said, "are caused by bad policies and shocking incompetence inflicted on the
whole service from the top, from Whitehall". He called for the Government to
stop reorganising the NHS, stop interfering in the
local planning of services, and stop using external management consultants to
tell NHS doctors and managers how to run their services, which he said was
costing £1bn a year "without any clear benefit".
Summary by
Keep our NHS Public
of
Telegraph 7 June 2006
Little time to
remove large blot. Michael White writes: "Like Unison, many consultants (who
have also lost autonomy and scope for over-priced private practice, thanks to
Labour's reforms) are under the cosh of quasi-market reforms promoted by Alan
Milburn, John Reid and now Ms Hewitt. More
patient choice, more
competition and
no guaranteed hospital
income, are proving harder than meeting waiting list targets. But voters'
patience is stretched and Guardian/
ICM polls report that the Tories are finally ahead on health… Tory and Lib Dem
complaints have some force. Labour's constant structural
reforms of the NHS have demoralised
staff, not least by ending up suspiciously
close to the Thatcher reforms demolished by Labour in 1997. Ms Hewitt has
less time than she thinks to get it right and to persuade voters to stay l |